Pediatric Immuniztions by maclaren1


									                                                                                      Pediatric Immuniztions
    Immunization*           Transmission                     High-risk                           S/S/ complications                     Vaccine complications*                  Contraindications*
Hepatitis A             -thru fecal-oral route   -children 5-14 yoa              -lethargy                                       -local reactions include soreness at     -hx of anaphylactic rxn to 2-
-inactivated whole                               -travelers                      -nausea                                         injection site                           phenoxyethanol or alum
virus                                            -MSM                            -vomiting                                       -systemic reaction includes              -children who are moderately
->20yr of immunity                               -illicit drug users             -anorexia                                       headache & anorexia                      or severely ill
-rec'd for kids > 1yr                            -pts w/ chronic liver dz        -muscle aches                                                                            -precaution: pregnancy (low
-2 inj at least 6 mo                             -pts w/ clotting factor         -abdominal pain                                                                          risk b/c inactivated vaccine)
  apart                                          disorders                       -jaundince/ dark urine
                                                 -working w/ primates            Complications: fulminant hepatitis rare, no
                                                                                 chronic infection
Hepatitis B             -contact w/ infected     -adolescence & adults           3 phases:                                       -local rxns include redness,             -hx of life-threatening allergy
-recombinate Hep B      blood or body fluids     -multiple sex partners           1. Prodromal: lethargy, anorexia, rash,        swelling, warmth at injection site       to Baker's Yeast
surface antigen                                  -MSM                                 mus aches, arthralgias, V/D                -systemic reaction includes fever &      -hx of life-threatening rxn to
->15yr immunity                                  -IV drug users                   2. Icteric: jaundice, splenomegaly,            irritability, fatigue & HA               Hep B vaccine
-3 dose schedule (1st                            -hemodialysis pts                     lymphadenopathy                                                                    -moderately to severely ill
dose at birth)                                   -recipients of blood products    3. Convalescence- cirrhosis,                                                            pts
*see below                                       -health care workers                 hepatocellular carcinoma
Diphtheria              -contact w/ infected     -very young & very old          -fever & chills                                 DTaP vaccine: big "D" vs little "d":     -children who are moderately
                        person or carrier or                                     -cough, hoarseness, & sore throat                Big D has 3-4x more toxins (give        or severely ill
                        by airborne droplets                                     -serosanguinous nasal discharge                  to kids < 7 yo) give little d to        -children w/ previous life-
                        -Corynebacterium                                         -N/V                                             kids > 7 yo                             threatening rxn to DTaP
                        diptheriae                                               -characteristic pseudomembrane formation         -given in 4 doses w/ booster            vaccine
                                                                                 Complications: airway obstruction,                                                       -children w/ encephalopathy
                                                                                 myocarditis, polyneuritis, pneumonia,           complications                            w/in 7 days of previous dose
                                                                                 thrombocytopenia, & proteinuria                 -local rxns include redness,             of DTaP vaccine (absolute
Tetanus                 -contaminated of         -age-independent risk           -'d muscle tone & spasm                        soreness, & swelling at injection        contraindication)
                        puncture wound or                                        -tachycardia                                    site
                        cut                                                      -HTN                                            -systemic rxn includes fever,            -Administer w/ caution if:
                                                                                 -sweating & fever                               drowsiness & irritability                 -w/in 3 days of previous
                                                                                 Complications: pneumonia, lethal glottal &      -uncommon rxns include crying >          immunization: seizure
                                                                                 pharyngeal spams, cardiac arrest                3h, unusual or high pitched cry,          -w/in 48h of previous
Pertussis               -contact w/ infected     -infants & children < 2yo       1. Catarrhal stage: sneezing, rhinorrhea, &     fever > 105o, shock-like state,          immunization: follapse or
-vaccine coverage       person, airborne                                             tearing, low grade fever, mild cough        seizures & encephalopahty                shock-like state, persistent
may wane after 6-12     droplets, nasal                                          2. Paroxysmal stage- whooping cough, post-                                               crying > 3 h, or fever > 105
yrs                     secretions                                                   tussive vomiting                            -*must give kids APAP before &            -w/in 6 wks after previous
-adolescents & adults   -bordatella pertussis                                    3. Convalescent stage: lessened coughing        after this immunization b/c of the       immunization: Guillain-Barre
may contract                                                                     Complications- penumonia, acute encephalitis,   risk for febrile seizures!!              syndrome (pheripheral
pertussis & spread to                                                            seizures, malnutrition, otitis media                                                     weakness 1st- can lead up to
inadequately                                                                                                                                                              need for respirator)
immunized infants &
Haemophilus             -contact w/ healthy      children < 5yo, esp 6-12 mo     -fever                                          -local reactions include redness or      -children w/ previous life-
influenzae type B       carrier or infected                                      -headache & irritability                        pain at injection site (resoves in 12-   threatening rxn to Hib
(HIB)                   person; respiratory                                      -vomiting                                       24h)                                     vaccine
-conjugate vaccine:                                                              Complications- meningitis, bacteremia,          -fever                                   -children < 6wk of age (b/c
diphtheria protein,                                                              pneumonia, septic arthritis, cellulites,                                                 may develop possible
tetanus toxoid,                                                                  epiglottis                                                                               immunologic tolerance (less
meningococcal outer                                                                                                                                                       responsive to future doses)
membrane protein                                                                                                                                                          -children who are moderately
                                                                                                                                                                          or severely ill
     Immunization          Transmission                 High-risk                           S/S/ complications                        Vaccine complications                     Contraindications
Influenza             inhalation of          infants & children < 24 mo      -fever & chills                                  -local reactions include redness,          -anaphylactic reaction to
-strains selected     respiratory droplets   & adults > 50yr                 -sore throat & cough                             swelling, & warmth at inj site             eggs (rare)- ask pts if allergic
annually based on     or indirect contact    -long-term care facilities,     -headache & muscle aches                         -systemic rxn includes fever, chills,      to eggs before giving &
viral shifts                                 chronic diseases (ht, pulm,     Complications: acute otitis media,               myalgia, lethargy, runny nose, &           watch for at least 10 min
-2 types: trivalent                          etc), immunosuppressed,         pneumonia, encephalopathy, death                 Guillain-Barre syndrome                    after shot
inactivated (TIV) &                          HIV, long-term aspirin                                                                                                      -children who are moderately
live attenuated                              therapy, PG women in 2nd or                                                                                                 or severely ill
(LAIV) **see below                           3rd trimester                                                                                                               -precaution: Guillain-Barre
                                                                                                                                                                         syn w/in 6 wks after previous
Measles               airborne respiratory   infants > 6 mo                  -maculopapular rash                              MMR Vaccine; live virus; life-long         -pts w/ life-threatening rxn to
                      droplets               -adolescents & young adults     -high fever (103-105o)                           immunity; 2-dose series (1st at 12-        gelatin, neomycin, or MMR
                                                                             -URI symptoms                                    15 mo & 2nd at 4-6 yrs) given at           vaccine
                                                                             -conjunctivitis & photophobia                    lease 4 wks apart (in catch-up             -pts how are moderately or
                                                                             Complications: otitis media, pneumonia, &        schedule)                                  severely ill at time of
                                                                             encephalitis (15% fatal)                                                                    vaccination
Mumps                 droplets or direct     5-9 years of age                -fever                                           Complications:                             -women who are pregnant or
                      contact                                                -malaise & anorexia                              -local reactions include redness or        plan to become pregnant
                                                                             -headache                                        pain at injection site                     -pts who are
                                                                             -parotitis                                       -systemic rxns include fever, mild         immunosuppressed (HIV if
                                                                             Complications: meningitis &                      rash, arthralgias, &                       asymptomatic or mildly
                                                                             epididymoorchitis                                lymphadenopathy                            symptomatic & after chemo)
Rubella               Airborne respiratory   5-9 years old                   -maculopapular rash, malaise & anorexia          -uncommon rxns include                     -precaution giving to children
                      droplets                                               -headdache, arthralgias & fever                  thrombocytopenia, seizures, coma,          w/ thrombocytopenia,
                                                                             -rhinorrhea & conjunctivitis                     brain damage & deafness                    thrombocytopenic purpura,
                                                                             -postcervical lymphadenopathy                                                               TB or positive PPD
                                                                             Complicaitons: thrombocytopenia,                 (Guidelines available for suggested
                                                                             encephalitis, congenital rubella syndrome        intervals btwn MMR immunization
                                                                             (infected mother = eye problems in baby          & administration of antibody-
                                                                             (retinopathies, glaucoma, hearing loss, etc)-    containing products (immune
                                                                             vaccinate planning moms-to-be > 3mo before       globulins ( or transfusions)
                                                                             getting pregnant
Streptococcus         Contact w /healthy     -young children, adults > 65,   -fever & chills                                  None mentioned
pneumoniae            carier or infected     CV or pulmonary disease,        -Otalgia                                         -see below for more info
-PCV7 & PPV23         person; respiratory    renal failure or nephritic      -cough & URI symptoms
vaccines ***see                              syndrome, sickle cell,          -respiratory distress
below                                        anatoic asplenia, DM, liver     -meningeal symptoms
                                             failure, alcoholism,            Complications: meningitis, seizures,
                                             immunocompromised states,       bacteremia, pneumonia, otitis media, sinusitis
                                             CSF leaks, cochlear implants
Polio                 Fecal-oral (possible   1-16 years old, severe form     -fever, headache, & sore throat                  -IPV: pain at injection site            -patients w/ previous life-
-IPV, OPV             respiratory)           in adults                       -nausea, vomiting, diarrhea, & constipation      -OPV: vaccine-assoc paralytic           threatening rxn to neomycin,
****see below                                                                -muscle rigidity & pain, head drop               poliomyelitis- no longer                streptomycin, or polymyxin-B or
                                                                             -bladder & muscle paralysis                      recommended or available for            IPV
                                                                             Complications: respiratory failure &             routine, immunization in US             -pts wo are moderately or
                                                                             permanent paralysis (< 1%)                                                               severely ill at time of
                                                                                                                                                                      -caution: pregnancy
    Immunization*           Transmission                     High-risk                          S/S/ complications                        Vaccine complications*                 Contraindications*
Varicella (chicken      contact w/ respiratory   1-6 years                      -pruritic rash                                     -local rxns include soreness or         -children w/ life-threatening
pox)                    sectetions or vesicles                                  -fever, anorexia, malaise, & headache              swelling at injection site              rxn to previous varicella
-live virus vaccine                                                             complications: impetigo, cellulites (2o            -systemic rxn includes fever or mild    vaccine, gelatin, or neomycin
-immunity > 11yr                                                                bacterial virus from scratching itch w/ dirty      varicella rash                          -children who are mod-
-single dose btwn 12-                                                           hands) & scarring                                  -rare side effects include febrile      severely ill at time of
18 months (2 doses if                                                           -encephalitis & postherpetic neuralgia             seizure, encephalitis, stevens-         vaccination
> 13 yo given 4-8                                                               (shingles)                                         johnson syndrome, pneumonia, &          -women who are PG or plan
wks apart)                                                                      -myocarditis & pericarditis                        thrombocytopenia                        on becoming PG
                                                                                -pneumonitis, glomerulonephritis, congenital                                               -some immunosuppressed pts
                                                                                varicella syndrome
Neisseria               contact w/ respiratory   children < 2-4yrs old &        -fever, chills                                     -local reactions include redness &      -children w/ life-threatening
meningiditis            secretions               adolescents                    -nausea                                            pain at injection site                  rxn to previous
-MPSV-4 & MCV-4                                  -college freshmen in dorms,    -headache & aches                                  -systemic rxn includes fever, chills,   meningococcal vaccine or
##-see below                                     military recruits, routinely   -rash                                              irritability, HA, fatigue/malaise,      thimerosal if thimerosal-
                                                 exposed microbiologists,       -meningeal symptoms                                anorexia, diarrhea & arthralgia         containing version
                                                 travelers, terminal            Complications: meningococcemia, septic             -unusual rxns include neurologic        administered
                                                 complement deficiencies,       shock, disseminated intravascular coagulation      (seizures, paresthesias) & ?            -children who are mod-
                                                 functional or anatomic         septic arthritis, meningitis, purpura fulminans,   temporal relationship w/ Guillain-      severely ill at time of
                                                 asplenia                       limb loss, pneumonia, myocarditis, chronic         Barre syndrome                          vaccination

 *-More about Hep B:
    -HbsAg positive mother: hepatitis B vaccine w/in 12h of birth + Hep B immune globulin (HBIG) w/in 12h
    -HbsAg unknown mother: hep B vaccine w/in 12h of birth + HBIG w/in 7 days if mother found to be Hep-B Ag positive
    -Premature newborns < 2kg should receive HBIG w/in 12h if maternal status can't be determined w/in this time frame; wait til > 1mo if (-) mother
    -give when 1st born b/c if contract Hep B at early age, risk of developing chronic disease (cirrhosis, etc) is exponentially higher
**More about Influenza Vaccine:
    -TIV- split-virus vaccine grown in embryonated hen eggs (inactivated vaccine)          -can be given w/ other vaccines
         -must be administered annually                                                    -cannot cause influenza (b/c inactivated)
         -stored in refrigerator                                                           -safe & effective in 2nd & 3rd trimesters of pregnancy
         -recommended for: children 6-24mo & their caregivers & health care                -children < 8yr should receive 2 doses separate by at least 4 wks if receiving for the first time
   -LAIV- “flue mist”; live-attenuated vaccine grown in embryonated hen eggs               -administered by intranasal route
         -must be frozen & administered immediately upon thawing                           -should NOT be administered w/ other vaccines
         -may cause influenza                                                              -should NOT be used in pregnancy
         -acceptable alternative to IM vaccine for healthy persons age 5-49                -children < 8 yo should receive 2 doses separated by at least 6 wks
                             Approved Indications                                         TIV                                                       LAIV
              healthy person 5-49                                                      permissive                                                    yes
              health person > 50                                                          yes                                                        no
              residents of nursing homes                                                  yes                                                        no
              chronic pulmonary disorder                                                  yes                                                        no
              other chronic diseases*                                                     yes                                                        no
              pregnant women in 2nd & 3rd trimester                                       yes                                                        no
              health care workers                                                         yes                                                        yes
                 * includes chronic pulmonary or CV disorders, metabolic diseases (including DM), renal dysfunction, hemaglobinopathies, or immunosuppression
*** Penumococcal Vaccine:
 -Penumococcal conjugate vaccine (PCV7)
        -polysaccharide conjugated to nontoxic diphtheria toxin (7 serotypes)- these 7 serotypes make up 80% of invasive disease in small kids
        -used for routine vaccination of children < 24 months old (dosed at 2,4, & 6 months of age; boosters at 12-15 months of age)
 -Polysaccharide vaccine (PPV23)
        -purified polysaccharide capsular antigen from 23 serotypes
        -used for children > 24 months old w/ high risk conditions
        -single dose, followed by revaccination > 5 years after 1st dose if still at high risk
****Polio Vaccine:
  -IPV- 3 types of vaccine virus inactivated w/ formaldehyde
        -contains 2-phenoxyethanol, neomycin, streptomycin, & polymyxin-B
        -greater than 99% immunity after 3 doses; duration of immunity is unknown
        -given in 3 shot seies w/ booster dose
 -OPV- 3 vaccine virus; shed in stool following vaccination for 6 wks; problem b/c live vaccine- could spread disease
##More on Meningococcal Vaccines
 -Menomune (MPSV-4)- lyophilized polysaccharide vaccine administered SC
        -approved for children > 2yo (to 10 years + elderly)
        -administered as one time dose: revaccination at 2-3 yr after initial dose may be indicated for children at high risk of infection who are immunized @ <4 yoa
        -revaccination at 3-5 yr may be considered in older children at high risk
 -Menactra (MCV-4)- liquid conjugate vaccine (conjugated w/ diphtheria toxoid)
        -administered IM; indicated for pts 11-55 yo (not studied in elderly)
        -administered as a one time injection
        -all kids 11-12 and those entering high school get this!
                                                                            Vaccines Given According to age:
          Birth                  2 months                  4 months                     6 months                 15 months                 4 years                    12 years
-Hep B                    -Hep B                    -DTaP                      -Hep B                    -DTaP                      -DtaP                     -Tdap
-+/- HBIG if mother is    -DTaP                     -Hib                       -DTaP                     -Hib                       -IPV                      -Menactra
hep B positive            -Hib                      -IPV                       -Hib                      -MMR # 1                   -MMR #2
                          -IPV                      -pneumococcal              -IPV                      -Varicella
                          -pneumococcal                                        -Pneumococcal             -Pneumococcal
                                                                               -Influenza                -Hep A

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